MEDICARE: SARA MARIE KISKA LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	S.2512067	OH

General Provider Information

NPI Number	:	1255977831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA MARIE KISKA LSW

Provider Business Mailing Address
First Line	:	4211 SECOR RD APT 233
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-4224
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4211 SECOR RD APT 233
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-4224
Country	:	US
Telephone Number	:	814-795-2623
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	01/20/2026

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